Provider Demographics
NPI:1922120955
Name:THE ORELLANA INSITITUTE PC
Entity Type:Organization
Organization Name:THE ORELLANA INSITITUTE PC
Other - Org Name:THE ORELLANA INSTITUTE PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELBIN
Authorized Official - Middle Name:ALFREDO
Authorized Official - Last Name:ORELLANA
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:616-940-9001
Mailing Address - Street 1:832 FOREST HILL AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2326
Mailing Address - Country:US
Mailing Address - Phone:616-940-9001
Mailing Address - Fax:616-940-7355
Practice Address - Street 1:832 FOREST HILL AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2326
Practice Address - Country:US
Practice Address - Phone:616-940-9001
Practice Address - Fax:616-940-7355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEO045303101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101761232Medicaid
MI260D110460OtherBLUE CROSS BLUE SHIELD
MI101761232Medicaid
MI260D110460OtherBLUE CROSS BLUE SHIELD
MIB43008Medicare UPIN